Department of Behavioral Sciences and Learning.
Department of Psychiatry, University of Nairobi.
J Consult Clin Psychol. 2019 Jan;87(1):46-55. doi: 10.1037/ccp0000363. Epub 2018 Nov 15.
Although patient-therapist collaboration (working alliance) has been studied extensively in Europe and America, it is unknown to what extent the importance of working alliance for psychotherapy outcome generalizes to lower- and middle-income countries. Additionally, there is a need for more studies on the alliance using methods that are robust to confounders of its effect on outcome.
In this study, 345 outpatients seeking care at the 2 public psychiatric hospitals in Nairobi, Kenya, filled out the Session Alliance Inventory (SAI) and the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) during each session. The effect of alliance on next-session psychological distress was modeled using the random intercept cross-lagged panel model, which estimates a cross-lagged panel model on within- and between-subjects disaggregated data.
Changes in the working alliance from session to session significantly predicted change in psychological distress by the next session, with an increase of 1 point of the SAI in a given session resulting in a decrease of 1.27 points on the CORE-OM by the next session (SE = .60, 95% confidence interval [-2.44, -.10]). This finding represents a medium-sized standardized regression coefficient of between .16 and .21. Results were generally robust to sensitivity tests for stationarity, missing data assumptions, and measurement error.
Results affirm cross-cultural stability of the session-by-session reciprocal effects model of alliance and psychological distress-symptoms as seen in a Kenyan psychiatric outpatient sample, using the latest developments in cross-lagged panel modeling. A limitation of the study is its naturalistic design and lack of control over several variables. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
尽管患者-治疗师的合作（工作联盟）在欧美得到了广泛的研究，但工作联盟对心理治疗结果的重要性在多大程度上适用于中低收入国家尚不清楚。此外，需要更多使用对其对结果的影响具有稳健性的方法来研究联盟。
在这项研究中，345 名在内罗毕的 2 家公立精神病院寻求治疗的门诊患者在每次就诊时填写了会谈联盟量表（SAI）和临床结果在常规评估-结果测量（CORE-OM）。使用随机截距交叉滞后面板模型来模拟联盟对下一次就诊时心理困扰的影响，该模型对个体内和个体间离散数据进行交叉滞后面板模型估计。
从一次会谈到另一次会谈的工作联盟的变化显著预测了下一次会谈时心理困扰的变化，给定会谈中 SAI 增加 1 分，下一次会谈时 CORE-OM 减少 1.27 分（SE =.60，95%置信区间[-2.44，-.10]）。这一发现代表了介于.16 和.21 之间的中等大小的标准化回归系数。结果对稳定性、缺失数据假设和测量误差的敏感性测试基本稳健。
结果证实了在肯尼亚精神科门诊患者样本中，使用最新的交叉滞后面板建模发展，工作联盟和心理困扰症状的会谈间互惠效应模型具有跨文化稳定性。该研究的一个局限性是其自然主义设计和对几个变量的控制不足。（PsycINFO 数据库记录（c）2018 APA，保留所有权利）。
